New Online Shopping Intake

Flood Nerd Shopping form
  • In what County is the structure located?
  • Date Format: MM slash DD slash YYYY
    What day will policy coverage begin?
  • Residential structure up to $250,000/ Commercial structure up to $500,000. Other options are available upon request after the initial quote.
  • Only available for primary or secondary residential structures.
  • $5,000 is the recommended deductible for optimum premiums. Other deductible options available upon request after initial quote.
  • In what flood zone is the structure located? If you don't know, that's ok! AE will be the default flood zone as most structures requiring flood insurance are in this zone. Zone will be confirmed through further research.
  • Has the structure ever suffered damage from external flooding conditions (i.e., water seeped in from the rain, through the window well, river backed up, etc.)? If yes, please give the amount of payout in notes.
  • This is a building or structure that is unfinished but actively being worked on.
  • If yes, please list the other structures in the additional information section.
  • Is there any other information you would like us to know at this time pertaining to your initial quote?
  • Section Break

  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
    Please upload the Elevation Certificate, Declaration page and/or photos that you can. You can uplaod as many as 5 files. If you need more please email